Diana Zuramskiene

Preliminary Matters

Service

1. The Hearings Officer provided an unredacted copy of the service documentation to the Panel, which included:

a. a copy of the Notice of Hearing dated 9 June 2023;

b. a copy of the unredacted certificate of registration dated 9 June 2023 which contained the Registrant’s registered postal and email addresses;

c. a certificate of service confirming that the Registrant was sent the Notice of Hearing on 9 June 2023 via her registered email address;

d. emails dated 5 and 10 July 2023 sent by the Hearings Officer to the Registrant regarding the issue of attendance at the hearing.

2. The Panel noted that it was not required to assess whether the Registrant had received the Notice of Hearing, merely to be satisfied that the HCPC had served notice properly. The duty to ensure that registered details are up to date rests with the Registrant. The Panel was conscious that the Registrant was unrepresented throughout the proceedings and it was therefore incumbent on the Panel to ensure that the proceedings were fair to all parties to the hearing. This position was confirmed in the Practice Note entitled ‘Unrepresented Registrants’ published by the HCPC for the assistance of Panels and registrants.

3. The Panel received advice from the legal adviser, which it applied, and was satisfied that the HCPC had discharged its obligations to effect service upon the Registrant in accordance with Rules 3 and 6 of the HCPC (Conduct and Competence Committee) (Procedure) Rules 2003 (the Rules) – it therefore found that good service had been effected.

Proceeding in Absence

4. The Presenting Officer applied for the hearing to proceed in the absence of the Registrant. He noted that the Panel had found good service of notice of the proceedings and that the Registrant had not actively engaged with the regulatory proceedings since February 2020. She did not attend either the substantive hearing in 2021 or the review of the substantive order in July 2022. He told the Panel that the Registrant appeared to have voluntarily absented herself from the proceedings – she had not requested an adjournment of the proceedings or provided any reason why she was unable to attend the hearing. There was no suggestion that adjourning the hearing would secure her future attendance. The Presenting Officer therefore invited the Panel to proceed with the hearing in the Registrant’s absence.

5. The Panel received legal advice, which it applied, and considered the Practice Notes provided to it (Unrepresented Registrants and Proceeding in the Absence of the Registrant). It noted that while there is a presumption that registrants will attend a hearing, the Panel has discretion to determine whether to proceed with the hearing in the event that a registrant is not in attendance. It had not received any request for an adjournment, or any request from the Registrant that she be represented in the proceedings. There was no information from her to explain her absence or to confirm whether she may, at some future point, be able to engage with the regulatory proceedings. The allegations arose in 2018, and were determined at a hearing in 2021.

6. The Panel was conscious of its overarching objective of protecting the public, and the factors identified in the case of R v Hayward [2001] EWCA Crim 168 in considering whether to proceed in absence or not.

7. The Panel was satisfied that the public interest in progressing matters in this case outweighed any prejudice which may be caused to the Registrant by proceeding in her absence. It was conscious that proceedings should not be adjourned without good cause, which was absent in this case - the Registrant had not engaged in the regulatory proceedings since 2020, when she indicated she would not participate. Further, she offered no explanation for her absence at any of the previous hearings, and did not request to be represented or for the proceedings to be adjourned to allow future attendance. The Panel did not believe that any useful purpose would be served by adjourning the proceedings to attempt to secure her future attendance. It determined that the Registrant had voluntarily absented herself from the proceedings.

8. In all the circumstances of this case, the Panel was content to exercise its discretion to continue the hearing in the absence of the Registrant.

Background

9. The Registrant graduated with a degree in Radiography in Lithuania. She registered with the HCPC as a Radiographer and was employed as a Band 5 Radiographer by the Swansea Bay University Health Board (“the Board”) at Singleton Hospital (“the Hospital) from 13 August 2018. Concerns about the Registrant’s competence arose on her first day of work. Management at the Hospital took steps to manage those concerns, including mandating that the Registrant not practise alone and only see adult patients. The Registrant did not pass her induction period and was provided with a training programme to address the concerns as to her competence.

10. The Hospital sought assistance from the Human Resources department, and capability processes were commenced. The Registrant was assessed further during this process, and showed some improvement, but did not improve sufficiently to remove the concerns as to her competence. A capability hearing took place on 12 December 2018, following which the Registrant sought redeployment. She was downgraded to a Band 2 Assistant Practitioner in the Radiography Department and supported by the Hospital to apply for an Assistant Practitioner Course run by Cardiff University. Had she successfully completed this course, she would have attained the level of an Assistant Radiographer, and the Hospital could have employed her in a Band 4 role in the Radiography Department. The capability process was suspended while the Registrant undertook the course. The Registrant did not successfully complete the course and subsequently resigned from her post with effect from 25 September 2019.

11. The Hospital notified the HCPC of its concerns as to the Registrant’s competence.

12. A substantive hearing took place on 11 July 2021 in respect of the above allegations. The Registrant had made partial admissions in relation to some of the allegations in advance of the hearing, and all particulars were found proved and to amount to the statutory ground of lack of competence. The Panel found the Registrant’s fitness to practise to be impaired, and imposed a suspension order for a period of 12 months. The substantive panel found that the Registrant’s conduct was capable of remediation, but that this may be unlikely given the extent of the deficit of her knowledge. It noted that she had taken steps to remediate her lack of competence by engaging with the capability process, the support offered by the Hospital and enrolling on the Assistant Practitioner course, however she did not complete this and the substantive panel noted “it had no information regarding the Registrant’s current position, in particular whether she was still in the field of radiography and was taking steps to address the significant deficit in knowledge and practical training”. The substantive panel concluded that, in the absence of any engagement or information from the Registrant since February 2020, the Registrant had not remediated her lack of competence.

13. In respect of insight, the substantive panel recognised that the Registrant had some insight but found that “it did not appear that she fully understood the potential risk to patients, resulting from her lack of competence. In addition, Colleague A and VW had explained that the Registrant ‘did not know what she did not know’, and this indicated to the Panel that she did not fully appreciate the extent of the deficit in her knowledge, or the level of remedial action required in order to meet the required level of competency.” It concluded that there was a high risk of repetition in the absence of fully developed insight and remediation. Further, while the Registrant may not have set out to cause harm, and was not reckless or negligent, she had exposed patients to a risk of harm, including unnecessary doses of radiation due to x-rays having to be repeated, and exposing foetuses to radiation due to not undertaking appropriate checks on women of childbearing age.

14. The substantive panel found the Registrant impaired on the personal component as a result, and also on the public component as it was satisfied that public confidence in the profession would be undermined if a finding of impairment was not made.

15. The Suspension Order imposed by the substantive panel was reviewed by a reviewing panel on 13 July 2022. It found “the absence of any engagement by the Registrant has the consequence that there are no grounds on which the present Panel could find that any of the failings identified at the substantive hearing have been addressed. That being so, it is to be assumed that the Registrant is not capable of practising autonomously as a Radiographer, and there would be a very significant risk of repeated errors with serious implications for patient safety were she to be permitted to return to practise without restriction.” It concluded that a further period of suspension was required for a period of 12 months, and warned the Registrant that suspension for more than two years would open to future reviewing panels the ability to consider strike off as a sanction.

Decision

16. The Panel had regard to the legal advice provided and the Practice Notes and sanction policy to which it had been referred, together with the relevant caselaw in respect of impairment. It was conscious that its role was not to go behind the findings of previous panels, but rather to assess the current state of the Registrant’s impairment. If it found the Registrant still to be impaired on either the public or personal component, it would consider what, if any, sanction would be appropriate in all the circumstances of the case.

17. As with the two preceding hearings of this matter, the Registrant provided no information as to her current circumstances. She did not provide information as to whether her insight had improved or explain whether the deficiencies in her competence, as identified by the substantive panel, had been remediated. She had not identified whether she wished to remain in the profession and what, if any, steps she had taken to maintain and advance her professional knowledge. Given that it is for the Registrant to persuade the Panel that the concerns about her competence have been, or are being allayed, the Panel finds itself in the same position as the previous reviewing panel. There is no evidence of any steps being taken by the Registrant to address the concerns about her competence, or any current evidence as to her level of remorse, remediation, insight and education, or how she has applied these to address the concerns of her regulator in relation to her competence. The Panel could only conclude that the Registrant remains impaired on the personal component.

18. Given the comprehensive lack of engagement with the regulator and the regulatory concerns, the Panel was entirely satisfied that a finding of impairment continued to be required on the public aspect of impairment. The Panel determined that members of the public would be shocked if a registrant who had been out of contact with her regulator for over 3 years, and who had provided no information as to her current professional development or practice, was found to be no longer impaired. It considered that a finding of impairment was required to uphold professional standards and maintain public confidence in the profession and the regulator. Accordingly, the Panel concluded that the Registrant’s fitness to practise remains impaired through lack of competence.

19. Having found impairment, the Panel went on to consider the appropriate level of sanction. It gave no substantial consideration to taking no further action, issuing a caution order or requiring mediation, considering these outcomes to be wholly inadequate responses to the concerns identified. The risk of repetition, lack of developed insight and inability to demonstrate sufficient, if any, improvement following the provision of support through the capability process and the undertaking of professional training, demonstrated that a conditions of practice order would not adequately protect the public from the lack of competence demonstrated by the Registrant to date. The Registrant was not able to work alone when employed by the Hospital more than 4 years ago and in the absence of any information from the Registrant to explain how those concerns had been adequately and appropriately addressed, the Panel did not consider that it could formulate conditions of practice which would adequately protect the public.

20. The Panel went on to consider whether a further period of suspension would allow the Registrant to address the regulatory concerns and remediate her fitness to practise. It noted her comprehensive failure to engage in the regulatory proceedings or demonstrate any intention to return to the profession. In the face of a registrant showing no inclination to take any steps to address the serious fitness to practise concerns identified, the Panel was satisfied that the appropriate and proportionate sanction to impose in this case was now an order striking the Registrant from the Register. This option was open to it as a consequence of the order being reviewed expiring on 11 August 2023, which was more than 2 years since the first Suspension Order took effect.

21. In reaching this conclusion, the Panel paid careful regard to the Sanctions Policy adopted by the HCPC, conscious that striking a registrant from the Register is a draconian last resort. It concluded however that as the Registrant has, by the expiry of the current order on 11 August 2023, been suspended continuously for two years, and in that time has not demonstrated any insight or willingness to resolve the regulatory concerns, it was appropriate, proportionate and in the public interest to strike this Registrant from the register. There was no useful purpose to be served by tethering an unwilling and disengaged registrant to the profession. It was aware that this action could have a substantial adverse impact on the Registrant, however it had no information from her as to her circumstances and could not speculate as to what the impact of the order, if anything, would be.

22. The Panel therefore directs that the Registrar strike the Registrant from the register upon the expiry of the existing Suspension Order on 11 August 2023.

ORDER: The Registrar is directed to strike the name of Mrs Diana Zuramskiene from the HCPC register.

The Order imposed today will apply from 11 August 2023.

History of Hearings for Diana Zuramskiene